Addison Disease

Prevalence 1:100,000 persons

M:F ratio: 1:1.8

CV instability, labile BP, hypotension, shock

Hypovolemia, hyperkalemia, cardiac dysrhythmia

Limited response to vasopressors

N/V and diarrhea leading to dehydration, electrolyte imbalances, and acid/base disorder.

Acute adrenal insufficiency leading to hypotension and refractory distributive shock.

Cardiac dysrhythmia caused by hyperkalemia.

Hypoglycemia and uremia, muscle weakness, decreased level of consciousness.

Addison disease is a specific type of adrenal insufficiency due to a primary inadequate production of glucocorticoids, mineralocorticoids, and androgens by the adrenal glands.

Nonspecific symptoms and insidious disease progression often result in a delay in diagnosis until after the development of addisonian crisis after a significant stressor or illness.

Pts often present with chronic fatigue as well as GI disturbances; pain, nausea/vomiting, diarrhea, and may develop episodes of mental status changes.

Diagnosed by cosyntropin stimulation test; administration of cosyntropin will stimulate ACTH secretion by pituitary but will not increase cortisol levels.

May be associated with other autoimmune conditions

Drugs that inhibit cortisol biosynthesis will trigger addisonian crisis; etomidate, antifungals.

See also Adrenal Insufficiency, Acute or Secondary.

80% of cases are due to immune destruction of the adrenal cortex by autoantibodies.

Most often an antibody against 21-hydroxylase. Presence of these autoantibodies may predate development of clinical disease by decades.

Other causes include infection (TB, histoplasma, HIV, CMV), cancer metastases, bilateral adrenalectomy, sepsis especially meningococcal, hemorrhage, and infiltrative diseases.